Protect your workers’ comp claim by watching out for these denial tactics
After filing a workers’ compensation claim, you might fear a backlash from your employer or the insurance company. Insurers and employers often don’t want to pay out money for a claim, so they look for reasons to deny your valid claim.
It could involve taking the case to court more than one time with your attorney in order to get the fair compensation that you deserve after being injured. These are some common workers’ compensation defenses that are often used as a way to keep from paying out on a claim.
Tactic #1: Failure to give proper notice
Typically, you need to give your employer proper notice before filing a workers’ comp claim. You usually need to provide notice within 30 to 90 days after you’re injured if you plan to file a claim. This way all of the necessary paperwork can be gathered together and presented to your attorney, the insurance company representing the employer, or the court—depending on whether or not the claim can be handled in a mediation setting.
A common defense that employers use is that you didn’t give proper notice or that you informed the employer about a claim well after the injury occurred. Any notice that’s given should be done in writing so that there is documentation with a date and the details of the injury as well as why you’re seeking compensation. It’s also a good idea to give a copy of the notice to your attorney and your doctor so that more than one person knows of your intentions.
Tactic #2: Missed deadlines
The statute of limitations for filing a claim is usually different in each state. In Georgia, you have up to 1 year after the injury to file a claim if you plan to seek compensation from the employer. This is separate from the length of time that you have for informing the employer about your injuries, which is 30 days. If you’ve been exposed to a chemical and develop an illness, then the statute of limitations may be extended.
Your employer could use the defense that you waited too long to file a claim and therefore should not be entitled to any kind of workers’ compensation settlement. This is when any documents with a date will be beneficial so that there is proof that you did in fact file a claim within the established timeframe.
Tactic #3: Outside the course and scope of employment
Your employer or the insurance company could claim that your injury occurred outside the course and scope of your job. Or they could claim that you were not on the job when the injury occurred. An experienced lawyer can help you document exactly when and where the injury happened—namely, that a work injury or accident took place on work property or while performing standard work duties.
Tactic #4: Horseplay or coworker violence
Another way that your employer could try to deny your claim would be to claim that your injuries are a result of violence or horseplay with another employee. You need to have your injury documented by a doctor as soon as it occurs so that there is some kind of proof that it happened while you were at work.
Tactic #5: Failed to seek treatment
Another common defense used to deny coverage is that the injured worker failed to seek the proper treatment right away. As a result, insurance companies may argue that the injury turned into an infection or something more severe because of a failure to receive timely treatment.
If they can prove that this is true, then you likely would not be eligible for receiving workers’ compensation. These are details that you need to keep in mind when you’re making your reports—that way there is no question when you go to court regarding when and how you were injured.
Tactic #6: Missed medical appointments
Sometimes, your employer or the insurance company might request that you go to a certain number of appointments with your doctor after being injured so that the details of your injury and treatment can be documented.
Keep in mind that you might have to visit your employer’s doctor as well in order for the company to obtain their own details about the injuries that you’re claiming. Your employer could claim that you didn’t go to your appointments—and if you didn’t, then it could mean that you aren’t as seriously injured as you have claimed. This is important for establishing the amount of monetary benefits that you could receive as well. If you’re unable to work or need to perform limited tasks, then a doctor’s note will usually be needed.
These are just a few of the ways insurance companies may try to deny your workers’ compensation claim, even if your injury is valid. Be sure to reach out to a trusted workers’ comp attorney in order to fight back against these claims, and receive the maximum benefits available to you.